Before methotrexate and the biologics became treatments of choice for RA, methotrexate in the 1990s and the first biologic in 1998, there wasn’t much that worked. Patients were given injectable gold, lots of aspirin. Sulfasalazine was the first drug to target RA but is was soon overshadowed by a rough form of the new steroids during 1950s. So, RA treatment has come a long way with the acceptance of methotrexate and the development of the biologics. But has it really come that far? According to the Cleveland Clinic only 30% of those treated with biologics have a technical remission. Thirty percent have no relief at all and the rest range in relief from 20% to 50%. And those numbers only reflect those patients who are being treated.
The study did not include those who have given up on the medical community including those who cannot afford treatment and those who cannot afford the expensive trial and error method of treating RA with the biologics. It does not include those whose treatment failed. Maybe the drugs worked for a brief time and then stopped. Maybe the side effects and the complications of the drugs were intolerable.
My success with Orencia falls in the 20-50% range. The first few days after taking Orencia I have severe joint pain. The pain lessens for a few days and then starts rebuilding before my next dose. I am rarely painless. But I am still better than I am without the Orencia. I have been through all the RA medications. Orencia is the only one working. It is the safest biologic. Methotrexate had worked about 50% but after seven years I developed black box warning thirteen, soft tissue necrosis. I healed after nine months of treatment plus one surgery.
The problems with today’s RA treatments:
- Trial and error
Matching a biologic medication treatment to the specific needs of a patient is a trial-and-error process. At this time it can’t be more specific than that. The drug either works or it doesn’t. The only recourse is to keep trying them until one works. Time consuming. Discouraging. Expensive.
Once you pass the basic DMARDs, the costs of RA medications soar. The RA biologics are some of the most expensive drugs on the market. The VA pays $3000 a month for my Orencia. Down at the drugstore, Orencia is about $5000. My Advantage program has a $300 a month copay for it. The drug companies have coupons that reduce costs. There are some restrictions and the reduced costs are available for a limited time.
The complications of RA medications are well documented. The most common is severe infection. There are increased risks for cancer and heart disease among other things. Doctors mention these complications in passing. They don’t want to frighten their patients. I have had three cancers, diverticulitis, and histoplasmosis. So my choices are limited.
- Nothing works
There are some who have temporary relief from their symptoms. There are some who have partial relief. And there are those who have no relief.
- New drugs better?
JAK inhibitors are the newest RA drugs. They are DMARDs (Disease Modifying Anti-Rheumatic Drugs.) They are not biologics. They are pills. They cause cancer like the TNF inhibitors and severe infections, heart disease. Risky.
What does all this mean? It means that although RA treatment has come a long way from the time where a life of pain and disability was guaranteed for those with rheumatoid arthritis, it has a long way to go. Treatment needs to be able to stop the symptoms and bodily destruction of rheumatoid arthritis. Treatment needs to have few side effects and no fatal complications. And it needs to be affordable. Until then, we can stop using the words ‘wonder drug’ to describe rheumatoid arthritis drugs. And we need to keep looking.